OASIS Alert
Muscle Weakness Coding Draws Intermediary Scrutiny
Don't fall for 728.2.
If you don't know the difference between the 728.x diagnosis codes and the 780.x codes when you answer M0230, expect to see downcoded claims galore.
ICD-9 codes 728.2 (Muscular wasting and disuse atrophy, not elsewhere classified) and 728.9 (Unspecified disorder of muscle, ligament, and fascia) are attracting attention - and downcodes - from medical reviewers at regional home health intermediary Cahaba GBA, the RHHI's June newsletter says.
The 728.2 code includes the diagnoses "Amyotrophia NOS" and "Myofibrosis" and can be used as a primary diagnosis if one of these conditions is the main focus of home care, Cahaba instructs.
"Many home health agencies are reporting 728.2 to code muscular weakness resulting from a temporary decrease, or non-use of a group of muscles, such as weakness resulting from a hospitalization," Cahaba reports. Instead, use a code from the 780.7 group "malaise and fatigue," the RHHI suggests.
Note: For instructions in using these codes appropriately, go to www.iamedicare.com/Provider/newsroom/newslines/0605.pdf.
On page three of ELGA find the provider number - in the PROV NUM field. Next, look in the INTER NUM field for the contractor number of the RHHI that processed the overlapping claim. Then, call the RHHI for contact information you need to contact the other HHA.
The RHHI codes and phone numbers are: Anthem (00180) 877-498-1351, Palmetto (00380) 877-272-5786, United Government Services (00450) 877-309-4290, United Government Services (California) (00454) 866-380-4745 and Cahaba GBA (00011) 877-299-4500.
"NAHC is urging all agencies that receive the survey to take the time to research the information requested and complete it," the trade group says. Survey findings will go into a congressional report on whether OASIS data should be collected for non-Medicare, non-Medicaid patients.
OASIS Alert
- Assessment:
Retrain Clinicians With New OASIS Q&As
But not everyone agrees with the answers. OASIS drives both reimbursement and outcomes, but years [...] - Therapy:
Prepare Now For Heightened Therapy Review
Beware of episodes with 10-12 therapy visits. If you can't justify every therapy visit, you [...] - Reimbursement:
Make Your Therapy Claims Audit-Proof
Expect more therapy downcodes - thanks to OIG audit. Medical review of claims with just [...] - Compliance:
Frequency Abbreviations Frequently Fail
Learn the right way to write orders. How you word orders for your plan of [...] - Outcomes:
Ignore Nutritional Needs And Outcomes Will Suffer
Key: Paying for a nutrition consult can be cost effective. By not assessing your patients' [...] - Nutrition:
7 OASIS Questions Shed Light On Nutrition Status
Hint: They don't all involve food. To improve patient outcomes, use OASIS to uncover nutrition [...] - Education:
How Broadly Do You Define Emergent Care?
Question: If a patient receives a home visit from a non-agency nurse practitioner because the [...] - Diagnosis Coding:
To Understand Sepsis Coding, Focus First On Definitions
Not every UTI is urosepsis. If you think sepsis is the same as septicemia, think [...] - Reader Question:
Is Edema A Lesion? It Depends
Question: When we looked at OASIS Question and Answer number 79 on the link from [...] - OASIS News:
Muscle Weakness Coding Draws Intermediary Scrutiny
Don't fall for 728.2.
If you don't know the difference between the 728.x diagnosis codes and [...]
